Dr. Meredith G Marten

More than a decade ago, at the beginning of my doctoral fieldwork, I was kidnapped and robbed one morning in Dar es Salaam, Tanzania. As I negotiated the logistical and emotional aftermath of this traumatic event, I took refuge in elite, privileged spaces. In doing so, I grappled with difficult problems: my privilege, my fear and feelings of vulnerability, and my broader moral concerns about Tanzania's poverty, gross wealth inequities, and the impacts these have on public health. Here, using Harrison's framing of multiple consciousness , I reflect on my vulnerability and privilege, and how they illuminate the impact the kidnapping had on my research and my perspectives on knowledge production. I call for our discipline to continue dismantling narratives of heroic fieldwork and to make more compassionate space for honest stories of our mistakes and privileges. Doing so would allow anthropologists to more faithfully account for fieldwork's messy unpredictabilities and tangled relations.

Senegal has long relied on local communities to expand health services and improve health outcomes for citizens and is internationally lauded for its effectiveness in promoting good health and facilitating local trust. Here we examine how community health care emerges in Keur Toma, a rural Wolof town in the Senegal River Valley that relies on a global network of labor migrants to fuel its remittance-based economy. Largely through its hometown association and the migrant men abroad who fund it, Keur Toma has built and sustained the local health infrastructure and staffing essential to achieving health care accessibility, providing consistent investment and critical stop-gap funding when government assistance falters. Following Robbins's call for investigating "an anthropology of the good," we highlight the deeply rooted sense of care and obligation to kin and community that fosters the translocal ties that make Keur Toma's health care possible in the state's absence. We highlight what Ngom calls "sanctified suffering"-which valorizes personal fortitude and the ability to endure hardships for family and community, shaped by traditions of solidarity, mutual aid, and Islamic morality-and its role in migrants' hometown commitments to building stronger communities.

Anthropologists have studied medical pluralism since the earliest, colonial days of the discipline, and the development of medical anthropology as a specific subfield itself was established through interests in the diversity of healing beliefs and practices observed across cultures. Traditional and complementary medicine has long been acknowledged by global health professionals as well (even though it is often not formally recognized nor adequately supported). Many of these types of care, particularly when provided alongside high-quality biomedicine when needed, offer the kinds of holistic engagement that biomedicine often excludes, particularly as nonbiomedical care often attends to the social aspects of health and well-being that are missing from biomedical practice. Given these 'realities', in this chapter we argue that high-quality biomedical care be made more accessible and available to improve the health and well-being of people around the world. We also hope to demonstrate how medical pluralism can often be valuable in improving patients' health, and, when appropriate, we encourage global health practitioners' support of plural forms of care around the world.

Forensic anthropology has recently and publicly grappled with fundamental disciplinary issues-including estimating population affinity, the pursuit of objectivity, and the role of bias in medicolegal contexts-all of which has left the subdiscipline in a state of seeming fracture, with many practitioners worried about its future. Given these concerns, we wondered to what degree polarization exists, if at all, and along what lines. Using the method of cultural consensus analysis, we asked forensic anthropologists: What makes a "good" forensic anthropologist? Our findings suggest that contrary to widespread concern, broad agreement (consensus) exists over the training, experiences, perspectives, and practices forensic anthropologists (n = 103) identified as important for being "good" at what they do. A few points of disagreement emerged-particularly over the issue of neutrality-which dominated the narrative feedback we received. The fault lines of this debate primarily fell along generational lines, with those having earned their degrees earlier believing more strongly in neutrality. This pattern largely maps onto broader (and somewhat routine) disciplinary debates and trends away from positivism, with younger anthropologists more focused on the larger goal of "decolonizing US anthropology" and attending to the antiracist work that figures prominently in anthropology today.

Human societies create and maintain structures in which individuals and groups experience varying degrees of inequity and suffering that may be skeletally and dentally embodied. It is necessary to foreground these social and structural impacts for forensic anthropologists to eschew biologically deterministic interpretations of human variation and overly individualistic interpretations of health and disease. We thus propose a ‘Structural Vulnerability Profile’ (SVP), akin to the Structural Vulnerability Assessment Tool of medical anthropology [1], to be considered along with the traditional ‘biological’ profile estimated by forensic anthropologists. Assembling an SVP would involve examining and assessing skeletal/dental biomarkers indicative of embodied social inequity—the lived experiences of social marginalization that can get ‘under the skin’ to leave hard-tissue traces. Shifting our emphasis from presumably hereditary variation to focus on embodied social marginalization, the SVP will allow forensic anthropologists to sensitively reconstruct the lived experiences of the people we examine.
•Traditionally, forensic anthropology emphasizes heredity and individual behavior in interpretations of biological variation.•A structural vulnerability perspective shifts the focus to the ‘upstream factors’ that structure human variation.•These influences include social, political, economic, and environmental determinants of health.•We propose a Structural Vulnerability Profile—SVP—akin to medical anthropology’s Structural Vulnerability Assessment Tool.•The SVP explicitly frames analyses of human skeletal and dental variation within the context of embodied experiences.

Strengthening health systems to provide equitable, sustainable health care has been identified as essential for improving maternal and reproductive health. Many donors and non-governmental organizations (NGOs) have contributed to undermining health system strengthening, however, through adhering to what Swidler and Watkins call the “sustainability doctrine,” policies that prioritize time-limited, targeted interventions best suited for short-term funding streams, rather than the long-term needs of local populations. This chapter presents ethnographic data from semi-structured and key informant interviews with 16 policymakers and NGO directors in Dar es Salaam, Tanzania from 2011 to 2012. I illustrate how sustainability doctrine policies were put into practice, and how they have persisted, despite their shortcomings, using examples of donor-prioritized maternal healthcare initiatives in Tanzania rolled-out several years apart: prevention of mother-to-child transmission of HIV (PMTCT) and basic emergency obstetric and newborn care (BEmONC) programs in the late 2000s, and more recent efforts to implement respectful maternity care (RMC) programs. I focus on several issues informants identified as crippling efforts to build strong health systems, particularly the internal brain drain of healthcare workers from the public sector to higher-paying NGO jobs, and the prioritization of types of programs donors believed could be sustained after the funding period ended, specifically trainings and workshops. I describe how despite these issues, international organizations still design and implement less effective programs that often fail to account for local circumstances in their efforts to solve some of the more intractable health issues facing Tanzania today, in particular, the country’s stagnating maternal mortality rate. In this chapter, I argue that practices promoted and implemented under the guise of “sustainability” in policy papers and reports generated by donors paradoxically contribute to health system precarity in Tanzania.

HIV and emotional distress often co-occur and interact in syndemic clusters with social, political, and economic factors that amplify the ‘syndemic suffering’ of individuals. In this paper, I describe how HIV+ women seeking antiretroviral therapy (ART) at a hospital in northern Tanzania engaged with plural methods of healing to ease suffering and address the multiple dimensions of illness. I explain the case of a famous faith healer at the time of research from 2011–12, ‘Babu wa Loliondo,’ from whom a third of the women interviewed – 25 of 75 –sought care in addition to their ART. These women experienced significantly fewer symptoms of emotional distress compared with those women who did not, suggesting that either those who sought his care were already healthier, or one strategy for coping – engagement with medical pluralism – played a role in buffering against syndemic HIV and emotional distress.

Fluctuations in global health funding can significantly impact the lives of people who depend on donor-funded programs for life-long care. In this article, I examine shifting HIV policies that expanded antiretroviral therapy (ART) while reducing “care” services meant to improve ART access and adherence. I describe how these changes were experienced by HIV+ women accessing ART at a hospital in Tanzania in 2011–2012, highlighting their increasing precarity and uncertainty for care amidst donor instability and eroding program services. This research suggests that stable funding in support of long-term care services is important to help HIV+ people maintain life-long ART.

Following three decades of international financial institutions implementing austerity measures in sub-Saharan Africa, many health systems remain chronically underfinanced. During this period, countries like Tanzania have moved from a post-independence vision of a strong social sector providing free care for citizens, to a model of increased privatization of public health facilities, shifting the burden of self-financing to individual health facilities and the constituents they serve. Drawing on longitudinal ethnographic research and document analysis
undertaken between 2008 and 2017 within three publicly-funded hospitals in north-central Tanzania, this article examines the actions and perspectives of administrators to explore how novel shifts towards semi-privatization of public facilities are perceived as taken-for-granted solutions to funding shortfalls. Specifically, hospital administrators used “side hustle” strategies of projectification and market-based income generating activities to narrow the gap between inadequate state financing and necessary recurrent expenditures. Examples from
publicly-funded hospitals in Tanzania demonstrate that employing side hustles to address funding conundrums derives from perverse incentives: while these strategies are supposed to generate revenues to sustain or bolster services to poor clients, in practice these market-based approaches erode the ability of publicly-funded hospitals to meet their obligations to the poorest. These cases show that neoliberal ideas promoting health financing through public-private initiatives offer little opportunity in practice for strengthening health systems in low
income countries, undermining those health systems' ability to achieve the goal of universal health care.